Transcript Anita Williams Falls Services Coordinator Pauline Sloan Specialist

ABMU East Area (Bridgend)
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A+E audit by 2 doctors in 2008 identified
that falls were poorly managed in A+E
Patients were rarely referred for further
investigation and prevention
Falls project Dec2008-April2009,A+E pilot
study for 1 week
Total
Average per day
Total
attendances
1251
178.7
65>
154
22
No. of fallers
36
5.1
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Followed up by telephone and home visit, if
required
Telephone assessment effective at
indentifying those who needed further
investigations
Despite low numbers would be considerable
amount of workload for one individual
Basic screening in A+E would be more
effective
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Patients 65> presenting at A+E not always being
asked if their injury is the result of a falls
Community Integrated Intermediate Care(CIIS)
Senior Nurse based in A+E trialed falls risk
screening tools
To identify a screening tool that was quick and
easy to complete but gave meaningful
information e.g Elderly Falls Screening Test(EFST)
Nurse in A+E delegated responsibility for looking
at consequences of falls/falls prevention in A+E
A&E FALLS SCREENING PDSA MAY 15-JUNE 11 2011
Name…………………………… Address……………………………………………………………..Age………Date in A+E…………
Risks…..
Tick yes or no for each of the statements below
1
Medical
problems
2
3
Balance,
strength
Fear of falling
4
Staying active
5
Vision
6
Feet and
footwear
7
Nutrition
8
Managing at
home
9
Hazards at
home
What if I do
fall?
I take sedatives, sleeping pills, fluid tablets, blood pressure pills
or 4 or more medications, or I am dizzy/unsteady or fall at times
or I can’t remember what happened when I fell
I have wobbly feet, weak legs, am unsteady, have difficulty
turning, climbing stairs or getting up from a chair
I am scared I will fall and/or I avoid activities in case I fall, or I
am not as active now
I walk less than 3 times a week for at least 15 minutes or I find
exercise difficult due to arthritis, heart or other problems or I
have been inactive for a long time
My vision is blurred/double or I have difficulty seeing steps,
walking in dim or glare/bright light or I have not had an eye test
in the last 12 months
My shoes have slippery soles, narrow or high heels, are
worn/old, have no fasteners, are too big/small or I wear
‘slippers’
I have had recent weight loss/poor appetite or have
osteoporosis or difficulty getting shopping or I eat less than 3
servings of dairy products a day
I have difficulty with some day to day tasks, washing, dressing,
getting to the toilet and/or I feel unsafe gardening, walking
and/or I have hazards around the home
My home is poorly lit, has uneven surfaces, obstacles or other
hazards that requires me to take extra care.
I don’t have a plan in I fall or I don’t know how to get up or I am
not confident that I would know what to do if I fell
10
INJURY
TREATMENT GIVEN
ADMITTED / WHERE?
Yes
DISCHARGE DESTINATION
Was the person referred to any follow up services on discharge, please tick any / all that apply
# Clinic
Day Hospital
Physiotherapy
Orthopaedic clinic
CIIS / ERS
Occupational Therapy
Medical OPD
Bridgestart
Osteoporosis
Cardiology
Social Services
GP
Other- Please specify
No
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Met with relevant personnel in A+E
Decision made by Nurse that the screening
tool be completed during the triage process
Pilot would run for a period of 4 weeks
Every patient 65> presenting at A+E would
be asked if their injury was as a result of a fall
Following intervention the bottom section of
the form would be completed by designated
nurse
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21 patients screened- could have been 4times as many
Female-76% 80>
Male- 23% 80>
Risk factors identified:Medical problems- 95%
Balance and Strength- 85%
Staying active- 71%
Fear of falling- 61%
What to do if they fell- 38%
Managing at home/hazards- 61%
Vision- 61%
Nutrition- 33%
Feet and footwear- 23%
Number of occurences of each risk factor
25
20
15
10
5
0
Medical Balance,
problems strength
Fear of
falling
Staying
active
Vision
Feet and Nutrition Managing Hazards What if I
footwear
at home at home do fall?
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Feedback from staff in A+E
The screening tool fulfilled the requirements
of being quick, easy and meaningful
From their experiences we have developed
the form further i.e after each question there
are signposting suggestions for positive
answers
Continue to work with colleagues in A+E
Aim – ensure that all patients 65> are
routinely asked if their injury is as a result of
a fall
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Now using an adapted version of the
screening tool for Public Health ‘Falls
Prevention’ campaign in the Bridgend area
2 GP surgeries
Linked to flu vaccine clinics
2 levels of screening
Falls Resource Pack
Any Questions???